BOX 6-1 Substantive Study Tasks*

  1. Establish criteria for near-term and longer-term assessment of the success of facility integration that can be used in follow-on assessments. Determine if success criteria would be different if the partner DoD health care facility was supporting operational units instead of basic/advanced training units, such as the Navy Health Center Great Lakes.
  2. Evaluate whether performance benchmarks that DoD and VA have established in their executive agreement have been achieved.
  3. Examine the lessons learned from similar mergers elsewhere in the federal and private health sectors that may be applicable to DoD/VA mergers.
  4. Evaluate the most pressing concerns of the stakeholders and recommend ways to mitigate or eliminate these concerns.
  5. Evaluate the specific impact of the merger on the level and quality of training received by active duty medical personnel and VA providers.


* The sixth task was to prepare a written report with findings, conclusions, and recommendations for the DoD and the VA that will be available to the general public.

which would provide lessons for designing more effective FHCCs in the future. Thus the evaluation framework looks at a much broader range of explanatory variables than internal processes (called implementation initiatives in the evaluation framework in Appendix B) that might affect outcomes, such as a single chain of command or integrated clinics. The broader framework includes the influence of the national and local contexts and of organizational capabilities and readiness. This approach makes it possible to understand not only if it is a successful demonstration (or not) but also which factors made it successful (or not).

Task 1 asks for criteria for assessing the “success” of the FHCC demonstration in the short term and the longer term. The framework in Appendix B considers short-term outcomes to be those observed in the first year or 2 and long-term outcomes to be those that emerge after 3–5 years. The Lovell FHCC is a difficult case because the phenomenon being demonstrated—an integrated health care center—was not fully in place the day it became operational and, in terms of having an electronic health record and other information management systems in place to support integrated operations, may not be fully in place within the 5-year time frame of the demonstration. Nevertheless, there will be lessons to learn, as Chapter 3 demonstrates, and some outcomes can be measured, although it might take several years to discern effects.

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